Update on Gem - Cushing's, bad news

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jkbank

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Hi All

I wanted to post a brief update on Gem's situation, and say thanks to all who have responded to my other post on her.

I have just left Gem at the internist (Blue Pearl Vet Center in NYC) where they are going to run the dexo….test to confirm or rule out Cushing's. They are also going to have the dermatologist have a look at her to see how we can better manage the open wound.

However, she does feel that given Gem's complicated medical situation, even with a positive Cushing's diagnosis, she is not sure she would advise on proceeding. Clearly, Gem is not a candidate for surgery. But she is just not sure how well Gem would respond to the medicines available, and how much quality-of-life that would buy her. The fragile skin presents a challenge as it puts her at risk for infection, makes her hard to handle and generally detracts from her being able to live a good kitty life. In fact, even if she tests negative for Cushing's, it's clear that something systemic is wrong and may not really be treatable. And even if the treatment for Cushing's managed to help regulate her diabetes (no guarantee there), it is a hard disease to manage in and of itself. Add to that the fact that she has heart problems, and you have an unhappy kitty - she is at risk for heart failure and clots etc.

My head is spinning, really. I am trying not to get too far ahead of myself. I opted to go ahead with the test for Cushing's just to see, so Gem is there for the day as they say it's an 8 hour test. When I pick her up tonight, I guess we will discuss a plan for her. I wish I knew what was the best thing to do. She doesn't appear to be in pain, though she pretty much just lays around. My kids will be devastated so I have to manage them as well. I don't want to put her through lots of tests and poking and prodding just to give her a few more months that are not really high quality. But I also don't want to give up on her just because that's "easier". Does that make sense?

Anyway, thanks for listening. I will try and post back later tonight with any more info.
 
Re: Update on Gem - Cushing's

jkbank said:
Hi All

I wanted to post a brief update on Gem's situation, and say thanks to all who have responded to my other post on her.

I have just left Gem at the internist (Blue Pearl Vet Center in NYC) where they are going to run the dexo….test to confirm or rule out Cushing's. They are also going to have the dermatologist have a look at her to see how we can better manage the open wound.

However, she does feel that given Gem's complicated medical situation, even with a positive Cushing's diagnosis, she is not sure she would advise on proceeding. Clearly, Gem is not a candidate for surgery. But she is just not sure how well Gem would respond to the medicines available, and how much quality-of-life that would buy her. The fragile skin presents a challenge as it puts her at risk for infection, makes her hard to handle and generally detracts from her being able to live a good kitty life. In fact, even if she tests negative for Cushing's, it's clear that something systemic is wrong and may not really be treatable. And even if the treatment for Cushing's managed to help regulate her diabetes (no guarantee there), it is a hard disease to manage in and of itself. Add to that the fact that she has heart problems, and you have an unhappy kitty - she is at risk for heart failure and clots etc.

My head is spinning, really. I am trying not to get too far ahead of myself. I opted to go ahead with the test for Cushing's just to see, so Gem is there for the day as they say it's an 8 hour test. When I pick her up tonight, I guess we will discuss a plan for her. I wish I knew what was the best thing to do. She doesn't appear to be in pain, though she pretty much just lays around. My kids will be devastated so I have to manage them as well. I don't want to put her through lots of tests and poking and prodding just to give her a few more months that are not really high quality. But I also don't want to give up on her just because that's "easier". Does that make sense?

Anyway, thanks for listening. I will try and post back later tonight with any more info.
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I would like to suggest you think back to the time when you first found out about the diabetes; I bet you were not sure that you would be OK with all that was required with testing and shots, but you did it, yes? I think it may be worth a try for the meds because you may well find that with the meds and your love and care, and also your kids, Gem may well turn around and improve greatly.

Others have told you that the meds for cushings did help, and for pain, well there are many pain meds to help in that area. I would definitely talk to the vet about pain meds and there is no reason you can't try some.... I also did not know if my Oliver was in any pains from his acromegaly, but I tried tramadol which did not seem to do anything, and then tried buprenex which made him a drunken sailor, and finally we found that gabapentin was a perfect fit for him! He perked right up and even in his face you could see the tired look and droopy eyes gone, leaving a wide eyed and happy kitty.

There are meds that help our kitties and without trying, you don't know their worth.
Best of luck with the results for Gem and I hope your discussion with the vet can put together a good plan of treatment for Gem.
 
Re: Update on Gem - Cushing's

It's good that you are getting the testing done, and that you will have more answers soon.

I am very sorry to hear what the doctors are telling you so far. If Gem could tolerate treatment for the Cushings (if that is what they diagnose), and if that helped you make progress with the wound situation, that would probably help with her quality of life quite a bit. I hope that the dermatologist has some suggestions for you.

Everything that you are saying makes sense. You have a lot to consider. From everything that you have said about your situation up to now, I don't think that you are one to give up because it is easier. Get the info from the vets and continue to take it one step at a time. Only you can judge if her quality of life is what you want it to be. If the vets can recommend treatment that could make her more comfortable, you will probably want to consider trying it. All I can suggest is to continue what you have been doing, which is taking it one step at a time, and continuing to get more information about what you are up against.

I am so sorry that you, Gem, and your family are up against such a difficult situation. It is clear that Gem has many people who care about her. I am hoping that Gem is not too upset after her day at the vet, and that the doctors can give you some hope for moving forward.
 
Re: Update on Gem - Cushing's

Thanks Linda and Gayle

I hope it doesn't come across that I'm giving up on gem. I certainly am waiting to hear what the results are. If there is something to be done for her, I will. Maybe I am mentally preparing myself.

Interestingly enough, when she was first diagnosed with diabetes, I was concerned, but never questioned treating her and doing what needed to be done. I knew enough to know that diabetes is manageable and cats can live long and happy lives. This all seems more dire, but perhaps that's just because I am in the dark right now.

We will see what the results are and go from there.
Thanks for your support!
 
Re: Update on Gem - Cushing's

Oh no, I never thought you had given up, but I did think that a bit of support sure could help you in your times of wondering.
I believe that so many of us go through times when we just don't know the best thing to do and when. .... if only we could get our animals to talk to us and help us with decisions, but nope. So it's really hard to know how we can do what's best.

I am sure that you are going to do all that you can for Gem, and I am pretty sure that Gem know you will do well by her too.
 
I just spoke to the vet and it is not good. The dermatologist and a surgeon looked at her skin and they both feel there is nothing they can do for her. Still waiting for the results on the Cushing's but they said even if it is that, and they start on the meds, best case scenario that would take a good month or so to start really working, and the skin would be the last thing to come around. In that time, she is at risk of more tears which would not only make it likely to develop infections, but also cause her pain. There are so many areas where her skin is so fragile that it can tear even with the gentlest of handling.

I am bringing her home tonight, and the family will discuss over the weekend what we want to do. My poor daughter is in tears and I don't know how to console her; she doesn't understand, which I get, because I don't either. Gem is still responsive and affectionate so she doesn't look like a dying kitty.

Think positive thoughts for us and my sweet Gem. Thanks.
 
I am so sorry to hear this. (((Gem))). I will send many positive thoughts for you and your family, as you spend your time with Gem over the next days.
 
:sad: I'm so sorry .. I hope as a family you all come to an agreement, on what should be done with Gem .. and find peace in that decision, if it ends up being a difficult one to make ..
 
Thanks to both of you for your good wishes. I feel so torn. The logical part of me says listen to what the doctors are telling you and let her go. But another part of me says get another opinion, maybe the meds could work. I don't want to give up but I don't want her to suffer. And I wonder how we would handle it if she had one of those really bad tears while at home with us. Or what if we weren't home when it happened. And this is not even taking into account the fact that she has diabetes, and a heart & kidney condition, which all have their own inherent risks. Ugh, life is hard, sometimes I wish I didn't have to be the grownup making these decisions!

OK, I'm off to pick up my sweet baby.
 
I know you'll do what's right for HER regardless of how much pain it will cause you.

My analogy: Bodies are like a plastic catsup bottle...after it's shaken, pounded, dropped, set on it's head, the lid opened/shut over and over, it breaks and can't hold the catsup anymore, you put it in another container. The catsup - the SPIRIT that makes her 'Gem' - is still the same, just in a 'different container'.

BIG HUGE HUG! I've been in your shoes way too many times the last 4 months, lots of thoughts and prayers from all 64 legs here...
 
I am glad she is coming home to you. Take your time to decide, and I know you will make the right decision when the time comes. I know that she will help you with the decision.
 
I am so sorry to hear about Gem. SO much to consider and such a difficult part of being a pet parent and with your own children to consider too - I am glad I never had to deal with that aspect. I am so sorry for your family dealing with all this. I can only say that, well, you seem to be doing all the right things and considering all the aspects of this and I will add that the whole quality of life issue is really where it's at for me at least. They can't tell us they are in pain and cats don't even really show it that well, they can't ask for us to make it easier, make it better or end it.
When I had to decide what to do about my 4 year old boy kitty who had Hyper Cardiomyopathy I was very concerned that I was heading towards ending it too fast because it was too much for me, too hard, too upsetting, too much work and so I decided I'd do whatever I had to so he'd get more time - I came home from work 2x a day to check him, give him meds, I stayed up all night with him holding him in the position he could breath best in. When he started started sitting at an angle on the fireplace hearth cause he could breath better that way I set up a pillow for him and was so happy when after showing him a few times he'd crawl onto it in the morning and still be there when I came home at lunch... than it hit me... NOW what I was doing was making him last longer FOR ME - so I'd feel better,feel I'd done "it all" and so I'd have him around. What kind of life was this poor boy living - waiting all day for me to come home and hold him for a half hour, give him meds to keep his heart going and shed water out of his system- was this a good life for him? As he'd choke on fluids, or start panting and I'd struggle to make him comfortable, it really didn't occur to me for a few days that perhaps I'd turned things around in the wrong direction. The night I thought of all this I was holding him against my face and I heard the blood squishing thru the valve in his heart that was defective - it was clear things had gotten MUCH worse (the vet confirmed this the next day) and I knew what I had to do.
I pray you get a clear signal for which direction you need to go - I am sure you will do the right thing for all concerned and especially Gem who I am sure loves and trusts you completely - don't be too hard on yourself this is not an easy situation - my heart goes out to you and your family and I hope that there is a positive answer for Gem but if there isn't know you did all you could do.
 
RobbiesMom said:
I am so sorry to hear about Gem. SO much to consider and such a difficult part of being a pet parent and with your own children to consider too - I am glad I never had to deal with that aspect. I am so sorry for your family dealing with all this. I can only say that, well, you seem to be doing all the right things and considering all the aspects of this and I will add that the whole quality of life issue is really where it's at for me at least. They can't tell us they are in pain and cats don't even really show it that well, they can't ask for us to make it easier, make it better or end it.
When I had to decide what to do about my 4 year old boy kitty who had Hyper Cardiomyopathy I was very concerned that I was heading towards ending it too fast because it was too much for me, too hard, too upsetting, too much work and so I decided I'd do whatever I had to so he'd get more time - I came home from work 2x a day to check him, give him meds, I stayed up all night with him holding him in the position he could breath best in. When he started started sitting at an angle on the fireplace hearth cause he could breath better that way I set up a pillow for him and was so happy when after showing him a few times he'd crawl onto it in the morning and still be there when I came home at lunch... than it hit me... NOW what I was doing was making him last longer FOR ME - so I'd feel better,feel I'd done "it all" and so I'd have him around. What kind of life was this poor boy living - waiting all day for me to come home and hold him for a half hour, give him meds to keep his heart going and shed water out of his system- was this a good life for him? As he'd choke on fluids, or start panting and I'd struggle to make him comfortable, it really didn't occur to me for a few days that perhaps I'd turned things around in the wrong direction. The night I thought of all this I was holding him against my face and I heard the blood squishing thru the valve in his heart that was defective - it was clear things had gotten MUCH worse (the vet confirmed this the next day) and I knew what I had to do.
I pray you get a clear signal for which direction you need to go - I am sure you will do the right thing for all concerned and especially Gem who I am sure loves and trusts you completely - don't be too hard on yourself this is not an easy situation - my heart goes out to you and your family and I hope that there is a positive answer for Gem but if there isn't know you did all you could do.
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Thank you Ellen, I am crying as I read your post. I almost feel the opposite, like I'm NOT ending it because it's too hard on me. In some ways she seems fine. But this skin thing is so distressing. I am praying for a sign from her that it's OK to let go.
 
I'm so sorry that Gem's condition has gotten to the point that you and your family need to make definite decisions. I know that is such a heartbreaking and emotionally/physically draining thing to go through. It's difficult to always feel comfortable in what the doctor's tell us is the right thing to do when our heart tells us otherwise. I hope that through the days you are given a sense of what you need to do. I suppose if you wanted to consider a second opinion, research as much info on the subject as you can on prognosis. That may help you decide if you want to go that route. I can certainly understand your concern in handling her with her skin as it is, and not wanting to cause any further damage.

My thoughts and prayers are with you, Gem, and your family.
 
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